Clinical Advances in Periodontics最新文献

{"title":"Use of microsurfaced acellular dermal matrix for the generation of site-appropriate keratinized tissue in soft tissue augmentation healing: Proof of concept.","authors":"Michael K McGuire, E Todd Scheyer, Kathryn E Davis, John C Gunsolley, Rick H Heard","doi":"10.1002/cap.70073","DOIUrl":"https://doi.org/10.1002/cap.70073","url":null,"abstract":"<p><strong>Background: </strong>Autogenous grafts remain the gold standard for soft tissue augmentation, but allogeneic dermal matrices (ADMs) offer a viable alternative. Limited cellular infiltration and neovascularization restrict ADM efficacy; this study investigates a novel microsurfaced ADM (MS-ADM) designed to address these limitations.</p><p><strong>Methods: </strong>This 180-day, randomized controlled trial evaluated the efficacy of MS-ADM grafts compared to nonmodified ADM in soft tissue augmentation for keratinized tissue generation. Ten patients (seven female, three male; mean age: 54.2 ± 10 years) with ≤1 mm of keratinized tissue were enrolled in a within-subject, examiner-blind trial. Each participant received paired MS-ADM and unmodified ADM (non-MS ADM) grafts at two sites. Healing was assessed via masked clinical photographs (Day 7/14), gingival inflammation scores, and histological biopsies at Day 90. Categorical endpoints were analyzed using McNemar's χ<sup>2</sup> test for matched data. Outcomes included keratinized tissue width (KTW), recession, probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and patient ratings of discomfort and were analyzed using repeated measures mixed-effects linear regression.</p><p><strong>Results: </strong>Evaluators consistently rated MS-ADM sites as exhibiting superior healing quality compared to non-MS ADM (p < 0.0001), significantly lower graft displacement (0% vs. 20%), and swelling (0% vs. 20%). Gingival inflammation scores were reduced earlier with MS-ADM, and texture matched surrounding tissue more rapidly. Both graft types generated ≥1 mm of keratinized tissue and clinically relevant KTW ≥2 mm by Day 180. Histology confirmed organized, vascularized mucogingival tissue in both groups but noted reduced inflammatory infiltrate with MS-ADM (n = 8).</p><p><strong>Conclusion: </strong>MS-ADM demonstrates superior early healing characteristics and reduced complications compared to non-MS ADM, suggesting it to be a superior alternative to conventional, unmodified ADM for soft tissue augmentation. However, the study's small sample size limits generalizability; larger and longer term trials are needed to confirm long-term efficacy and tissue thickness outcomes for soft tissue augmentation.</p><p><strong>Key points: </strong>Microsurfaced allogeneic dermal matrix (MS-ADM) demonstrated superior early healing quality and faster achievement of normal tissue texture compared to unmodified ADM. Both MS-ADM and non-MS ADM effectively generated clinically relevant keratinized tissue and improved key clinical parameters over 180 days. MS-ADM showed fewer complications, including graft displacement and swelling, suggesting enhanced biointegration compared to non-MS ADM.</p><p><strong>Plain language summary: </strong>A novel acellular dermal matrix patterned with microsurfaced partial-thickness cuts (MS-ADM) was developed to expand the host-graft interface surface area compared to u","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fixed contralateral anchored suturing for coronal flap advancement.","authors":"Pooria Fallah Abed, Stephanie Bowers, Wade Knight, Rodrigo Neiva","doi":"10.1002/cap.70064","DOIUrl":"https://doi.org/10.1002/cap.70064","url":null,"abstract":"<p><strong>Background: </strong>Fixed contralateral anchored suturing (FICAS) for coronal flap advancement is a novel suturing technique that utilizes ceramic attachments bonded to the buccal or lingual of the teeth as an anchorage point for suspensory sutures. This technique is designed to increase flap stability and improve graft adaptation in periodontal plastic surgery.</p><p><strong>Methods: </strong>Two patients with localized gingival recession defects were treated with connective tissue grafting. One case used a tunneling technique, and the other used a coronally advanced flap. A ceramic button is bonded to the tooth surface contralateral to the flap. This is the lingual surface in both cases presented. Subepithelial connective tissue grafts and flaps were coronally advanced using periosteal stretching and then secured with nylon sutures. The sutures are looped over the ceramic button in a specific suspensory configuration.</p><p><strong>Results: </strong>Follow-up at 2 weeks and 6 months revealed uneventful healing. No loss of sutures, ceramic buttons, or any postoperative infection occurred. The bonded buttons successfully protected the sutures and wound from disruption by tongue movements and food. There were visible increases in gingiva thickness, keratinized and attached tissue. Significant root coverage was achieved.</p><p><strong>Conclusions: </strong>The FICAS technique may be a viable alternative for tension-free coronal flap advancement and stable soft tissue adaptation, specifically in complex soft tissue cases such as a dehiscence or Recession type (RT)2 and RT3 defects. Additional research, ideally randomized controlled trials, is necessary to substantiate these observations and determine the long-term success of this technique compared to others previously described.</p><p><strong>Key points: </strong>Fixed contralateral anchored suturing used ceramic buttons as a remote anchorage point for suspensory sutures. Maximizing flap stability and minimizing tension on delicate tissues are critical factors for favorable healing in periodontal plastic surgery. Buttons bonded to the contralateral surface of the flap may improve esthetics compared to other suspensory suturing techniques.</p><p><strong>Plain language summary: </strong>Fixed contralateral anchored suturing technique is a new suturing technique that involves bonding a button to the tooth surface, which will hold suspensory sutures. Sutures play a critical role in holding the tissues in a stable and favorable position during initial healing. The authors aim to introduce this technique to improve upon the esthetics of previously reported suspensory suturing techniques, and potentially improve outcomes and root coverage in both simple and complex recession cases.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary oral rehabilitation after head and neck radiotherapy.","authors":"Fernanda C B S Bettero, Ana V G L C Oliveira, Ana L C Mendonça, Camila C A Lopes, Veridiana R Novais","doi":"10.1002/cap.70066","DOIUrl":"https://doi.org/10.1002/cap.70066","url":null,"abstract":"<p><strong>Background: </strong>Radiotherapy for head and neck cancer is associated with adverse oral effects, including salivary gland hypofunction, radiation-related caries, and periodontal tissue alterations, which negatively impact oral health and quality of life.</p><p><strong>Methods: </strong>A 56-year-old male previously treated with surgery, radiotherapy, and chemotherapy for oropharyngeal cancer presented with dentin hypersensitivity, gingival recession, and reduced keratinized tissue. A multidisciplinary rehabilitation was performed, including non-surgical periodontal therapy, free gingival grafting, restorative treatment of cervical lesions, prosthetic rehabilitation, and individualized preventive maintenance.</p><p><strong>Results: </strong>Uneventful healing was observed at all surgical sites. The free gingival grafts resulted in increased keratinized tissue and vestibular depth, with stable periodontal conditions and resolution of dentin hypersensitivity. Clinical stability was maintained throughout a 24-month follow-up period, with no adverse radiation-related effects.</p><p><strong>Conclusions: </strong>Multidisciplinary oral rehabilitation, including mucogingival surgery and preventive care, can be safely and effectively performed in irradiated patients, improving periodontal stability, oral comfort, and quality of life.</p><p><strong>Key points: </strong>Head and neck radiotherapy can cause long-lasting oral complications that require careful and individualized dental management. Periodontal surgery, restorative treatment, and prosthetic rehabilitation can be safely performed in irradiated patients when properly planned and followed. Long-term preventive maintenance is essential to maintain oral health and minimize complications in head and neck cancer survivors.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-year tomographic and clinical evaluation of the socket shield technique: Case report.","authors":"Renan Dalla, Khalila C Cotrim, Rafael A Siqueira, Eduardo C Kalil","doi":"10.1002/cap.70065","DOIUrl":"https://doi.org/10.1002/cap.70065","url":null,"abstract":"<p><strong>Background: </strong>The socket shield technique, one modality of partial extraction therapy, aims to preserve periodontal tissues and maintain the buccal alveolar bone volume following immediate implant placement or in prosthetic pontic sites, by the strategic maintenance of a tooth root fragment. This case report presents a 5 year-follow up of this technique, in a full maxillary implant-supported rehabilitation, evaluating the alveolar dimensional changes over time.</p><p><strong>Methods: </strong>A 54-year-old patient underwent a full maxillary implant-supported rehabilitation. Partial tooth extraction was performed on the five anterior sites, numbers 6, 8, 9, 10, and 11. In each site where the socket shield technique was performed, changes in alveolar dimensions at the cervical, middle, and apical levels were measured using computed tomography at baseline, 1, 3, and 5-year follow-up intervals. In addition, the Pink Esthetic Score evaluation was performed.</p><p><strong>Results: </strong>The mean values (mm) in the five evaluated sites, at each time period, were respectively: cervical = 7.92 ± 0.46; 8.38 ± 0.61; 8.28 ± 0.51; and 8.32 ± 0.47. Medium third = 7.84 ± 0.99; 8.18 ± 1.05; 7.22 ± 0.69; 7.24 ± 0.72. Apical = 6.84 ± 0.91; 6.88 ± 0.74; 6.40 ± 0.70; 6.40 ± 0.69.</p><p><strong>Conclusion: </strong>Despite its inherent limitations, this case report suggests that the socket shield technique can represent a promising alternative for the stability of peri-implant tissues, in pontic and implant sites.</p><p><strong>Key points: </strong>In this case report, the socket shield technique was able to preserve alveolar dimension in both implant and pontic sites at 5-year follow-up. Careful planning and execution are crucial to prevent interference between retained root fragments and prosthetic components. Patient satisfaction and favorable Pink Esthetic Scores demonstrated good esthetic outcomes with this technique.</p><p><strong>Plain language summary: </strong>Preserving bone and soft tissue volume and position after tooth extraction is a major challenge in implant dentistry, particularly in anterior sites. This case report illustrates the five-year follow-up of a patient who received a full-arch, implant-supported rehabilitation in the upper jaw using the socket shield technique. This approach preserves a portion of the tooth root to help maintain the natural contour of bone and soft tissues. Clinical and tomographic evaluations, along with esthetic scoring systems, were used to assess tissue stability and appearance over time. In this case report, after five years, the technique showed stable preservation of bone and gingival tissues, with favorable esthetic outcomes and high patient satisfaction. Although based on a single case, these findings suggest that the socket shield technique may be a useful option for achieving long-term tissue stability and esthetic success in challenging implant-supported rehabilitations.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Connective tissue graft wall technique with concentrated growth factors and allograft: A case series.","authors":"Hou-En Lin, Yu-Ting Tsai, Li-Wen Lin","doi":"10.1002/cap.70067","DOIUrl":"https://doi.org/10.1002/cap.70067","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Severe periodontitis often results in extensive attachment loss and non-contained bony defects, compromising regenerative predictability. This case series evaluates the clinical and radiographic outcomes of treating extensive infrabony defects with buccal dehiscence using a synergistic approach: the connective tissue graft (CTG) wall technique combined with freeze-dried bone allograft (FDBA) and concentrated growth factors (CGF).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two patients underwent regenerative surgery following initial periodontal therapy. Intraoperatively, two-wall, non-contained defects with complete buccal bone dehiscence were identified. The defects were grafted with \"CGF sticky bone\" (FDBA mixed with CGF). A CTG was secured to the interdental papillae and periosteum to establish a biological barrier, followed by a coronally advanced flap for closure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At the 8-month follow-up, both cases demonstrated significant pocket probing depth reduction (&lt;4 mm) and clinical attachment level gains (4-5 mm). While minor residual gingival recession and partial papilla collapse occurred, a notable increase in gingival thickness was observed. Periapical radiographs confirmed substantial infrabony bone fill and increased radiopacity within the previous defects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The combination of the CTG wall technique, FDBA, and CGF provides a viable strategy for managing complex, non-contained periodontal defects. This integrated approach effectively stabilizes graft materials and improves soft tissue quality, though complete prevention of recession in advanced defects remains a clinical challenge.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Regenerating non-contained infrabony defects remains clinically challenging due to compromised space maintenance and wound stability. This case series demonstrates that the CTG wall technique, integrated with FDBA and CGF, effectively manages these complex defects by providing a stable biological barrier. This approach yields favorable short-term CAL gains, substantial radiographic bone fill, and beneficial soft tissue phenotype modification, even in cases with extensive buccal bone loss.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Periodontitis is a severe gum infection that destroys the supporting tissues and bone around teeth, often leading to tooth loss. Traditional treatments sometimes struggle to fully regrow these lost structures. This study introduces a specialized surgical approach called the \"CTG Wall Technique.\" By combining a patient's own gum tissue with advanced blood-derived growth factors and bone graft materials, we created a biological \"wall\" to stabilize the wound and enhance healing. We applied this method to patients with deep bone defects and followed their progress. The results showed significant improvement in gum attachment and bone height. This technique offers a promising, biological way to save teeth that might oth","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subperiosteal peri-implant augmented layer to correct bone dehiscence at immediate implant placement.","authors":"Tommaso Grenzi, Chiara Franzini, Mattia Severi, Leonardo Trombelli","doi":"10.1002/cap.70070","DOIUrl":"https://doi.org/10.1002/cap.70070","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The purpose of the present case report is to describe the potential of the subperiosteal peri-implant augmented layer (SPAL) technique in peri-implant bone dehiscence (PIBD) correction at immediate implant placement (IIP).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This case report describes the application of the SPAL technique in two patients undergoing IIP at compromised sockets resulting in a PIBD. A split-thickness flap was raised to preserve the periosteal layer, which was coronally advanced to compensate the missing portion of buccal bone plate. A deproteinized bovine bone mineral graft, with or without autogenous bone, was placed beneath the periosteal envelope to reconstruct the buccal defect. Mucosal layer was used to achieve primary closure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both patients exhibited uneventful healing. At re-entry, complete PIBD correction was observed, with newly formed peri-implant bone extending to the level of the implant collar. Clinical and radiographic evaluation assessed healthy peri-implant tissues at prosthetic rehabilitation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;SPAL technique may be considered a simplified option in the treatment of PIBD at IIP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Peri-implant bone dehiscence (PIBD) requires treatment to prevent long-term biological complications, such as peri-implant disease and progressive bone loss and soft tissue dehiscence. Periosteal layer (PL) plays a key role by serving as a biologically active barrier that compensates for the absence of the buccal socket wall and converts the defect into a self-contained one, thereby supporting graft stabilization and bone regeneration. Severity of the PIBD, on one hand, and the extent of coronal advancement of the PL at surgical manipulation, on the other, may represent relevant limitations for the generalizability of the application of PL-based procedures for bone augmentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Immediate implant placement after tooth extraction can be complicated when part of the buccal bone is missing. This condition may compromise implant stability, peri-implant tissue health, and esthetic outcomes if not properly managed. This case report presents a surgical approach that uses the patient's own periosteum, a thin tissue layer covering the bone, to help reconstruct buccal bone defects at the time of immediate implant placement. The periosteum was carefully separated and repositioned to act as a natural biological membrane, creating a protected space that contained the bone graft and supported new bone formation. Two patients with buccal bone defects were treated using this technique in combination with bone graft materials. Healing occurred without complications. Clinical and radiographic evaluations showed complete correction of the bone defects, stable peri-implant tissues, and favorable esthetic outcomes. These findings suggest that the surgical use of the periosteum may represen","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of a severely atrophied maxilla using titanium-reinforced membranes: A case report.","authors":"Thaer Alqadoumi, Noor Daras","doi":"10.1002/cap.70071","DOIUrl":"https://doi.org/10.1002/cap.70071","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Severe maxillary alveolar ridge atrophy secondary to advanced periodontal disease presents a challenge for implant rehabilitation, particularly in patients with systemic comorbidities. Guided bone regeneration combined with sinus augmentation may provide an alternative to remote anchorage implants when conditions permit. This case has educational value for clinicians by illustrating a staged reconstructive approach for severe maxillary atrophy, including complication management and subsequent implant rehabilitation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 55-year-old male with uncontrolled diabetes mellitus presented with maxillary edentulism with severe horizontal and vertical bone loss of the maxillary arch due to a history of periodontal disease and requested implant-retained overdenture rehabilitation. After consultation regarding remote anchorage implants, the patient elected a staged regenerative approach. Glycemic control was optimized prior to surgery, with hemoglobin A1c reduced from 8.9% to 7.6%. Bilateral lateral window sinus augmentation was performed, followed by a 5-month healing period. Subsequently, full-arch guided bone regeneration using particulate grafting and a titanium-reinforced polytetrafluoroethylene membrane was completed. Membrane exposure occurred on the left side at 4 months and was managed by membrane removal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Cone beam computed tomography obtained 9 months after guided bone regeneration demonstrated adequate vertical and horizontal ridge dimensions to permit implant placement. Four implants were placed to support a maxillary implant-retained overdenture. At 1-year follow-up, peri-implant soft tissues and supporting bone levels remained stable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This case demonstrates that a staged regenerative approach combining sinus augmentation and guided bone regeneration can facilitate implant-supported overdenture rehabilitation of a severely atrophied maxillary arch in a patient with controlled systemic risk factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Staged regenerative therapy combining sinus floor augmentation and guided bone regeneration can facilitate implant placement in the severely atrophied maxilla when systemic conditions are appropriately managed. Titanium-reinforced non-resorbable PTFE membranes provide effective space maintenance for full-arch ridge reconstruction; however, membrane exposure remains a recognized complication that can be managed without compromising subsequent implant placement. Optimization of glycemic control and careful surgical planning may allow successful implant-retained overdenture rehabilitation in patients with a history of advanced periodontal disease and controlled diabetes mellitus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Severe bone loss in the upper jaw can make placement of dental implants difficult, especially in patients with medical conditions such as diabetes. Some patients are of","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous dental implant macro-migration in low-density bone: An 8-year case report.","authors":"Chia-Chin Tsai, Chieh-An Yi, Ta-Chung Chen, Hsuan-Hung Chen","doi":"10.1002/cap.70072","DOIUrl":"https://doi.org/10.1002/cap.70072","url":null,"abstract":"<p><strong>Background: </strong>Implant migration is an uncommon phenomenon defined as a change in the positional axis of a stable implant. This report describes a rare case of spontaneous macro-migration occurring during the healing phase in a site with poor bone density and evaluates its 8-year functional success.</p><p><strong>Methods: </strong>A 53-year-old female required implant placement in the maxillary left first molar (Universal tooth #14) site with low bone density (residual bone height: 4.2-5 mm). Following sinus floor elevation using particulate bone grafting, a 4 mm × 13 mm implant was placed (insertion torque: 35 Ncm; initial implant stability quotient [ISQ]: 63). Digital image registration utilizing a rigid-body transformation algorithm was employed to quantify migration at 4 months, 8 months, and 8 years.</p><p><strong>Results: </strong>Digital analysis confirmed a 12.8° mesial macro-migration within the first 4 months. Despite the shift, stability increased biologically (ISQ 63-78). A 15° angled abutment was used for prosthetic correction. At 8 years, the implant remained functionally stable with intact three-dimensional bone encapsulation on cone-beam computed tomography and minimal marginal bone loss.</p><p><strong>Conclusions: </strong>Spontaneous migration in low-density bone before graft maturation does not necessarily preclude successful osseointegration. Long-term stability can be achieved through prosthetic intervention.</p><p><strong>Key points: </strong>Clinical phenomenon: Spontaneous implant macro-migration can occur in low-density (Type IV) bone during the submerged healing phase, particularly when associated with immature particulate bone grafts. Diagnostic tool: Digital image registration utilizing open-source software is an effective method for clinicians to objectively quantify positional shifts and differentiate adaptive migration from pathological displacement. Treatment outcome: Dental implants undergoing significant spontaneous migration (up to 12.8°) can achieve successful osseointegration and 8-year functional stability when managed with appropriate prosthetic compensation using angled abutments.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diode laser-assisted periosteal fenestration for peri-implant vestibuloplasty: A clinical technique.","authors":"Won-Pyo Lee, Gwi-Hyeon Min, Hyun-Chul Park, Byoung-Sup Sohn","doi":"10.1002/cap.70068","DOIUrl":"https://doi.org/10.1002/cap.70068","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Peri-implant mucogingival deficiencies, characterized by a shallow vestibule and insufficient attached mucosa (AM), can compromise plaque control and maintenance. Periosteal fenestration offers a graft-free alternative but remains limited by technique sensitivity and restricted surgical access. This report introduces a hybrid diode laser-assisted periosteal fenestration protocol (Hu-PF) designed to improve clinical applicability while preserving biological safety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Hu-PF protocol separates surgical functions by restricting diode laser use to controlled soft-tissue dissection and performing definitive periosteal fenestration mechanically under irrigation. A representative case, supplemented by additional clinical examples, is presented to illustrate the procedural workflow.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The technique enabled predictable vestibular deepening and increased AM, with stable outcomes observed during follow-up. In the representative case, AM increased by approximately 6 mm at 1 week and stabilized at approximately 4 mm at 18 months, with maintained results at 3 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The Hu-PF protocol represents a clinically applicable modification of periosteal fenestration-based vestibuloplasty that improves surgical operability while preserving biological safety, providing a practical graft-free option for peri-implant mucogingival management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;The Hu-PF technique facilitates vestibuloplasty in anatomically challenging sites where periosteal suturing or graft stabilization is difficult, such as posterior regions or areas with prosthetic restorations. The protocol confines diode laser use to controlled soft-tissue dissection for hemostasis and visibility, whereas definitive periosteal fenestration is performed mechanically to stabilize the mucogingival junction without graft harvesting. The technique enables predictable vestibular deepening and maintenance of attached mucosa, with stable outcomes observed during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Patients with dental implants may have insufficient firm gum tissue and a shallow vestibule, making oral hygiene difficult and increasing the risk of inflammation. Traditional grafting can improve these conditions but requires a donor site and complex handling. Periosteal fenestration is a graft-free alternative, but it can be difficult to perform in areas with limited access. This report introduces a practical hybrid approach (Hu-PF) that uses a small diode laser only for soft-tissue separation to improve visibility and control bleeding, whereas a rotary instrument is used under water cooling to safely create a small periosteal window. By separating these steps, the technique maintains the handling advantages of the diode laser while reducing the risk of heat damage to bone. The approach enables increased vestibular depth and firm gum tissue, with","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10-year follow-up of adolescent leukemia diagnosed through gingiva: A case report","authors":"Gang Yang,&nbsp;Yuan Tu,&nbsp;Wenjie Hu,&nbsp;Xianghui Feng","doi":"10.1002/cap.10340","DOIUrl":"10.1002/cap.10340","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Systemic diseases often present initial signs through oral manifestations, making early recognition essential for accurate diagnosis and effective treatment planning. Patients with acute lymphoblastic leukemia (ALL) commonly experience gingival issues. This case report discusses the treatment and outcomes of a 12-year-old female patient who presented with gingival swelling and pain and was subsequently diagnosed with ALL.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The patient underwent chemotherapy and basic periodontal supragingival scaling. Comprehensive clinical assessments, oral photographs, and imaging data were recorded at the initial visit, and at follow-ups 8 years and 10 years later.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A routine blood test and bone marrow aspiration confirmed a diagnosis of B-cell acute lymphoblastic leukemia (B-cell ALL). After 1 year of chemotherapy with rituximab, the patient recovered and was discharged. An 8-year follow-up revealed significant clinical attachment gain and healthy gingival status, and complete recovery was observed at a 10-year follow-up.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Adolescents presenting with swollen and bleeding gums should be evaluated for potential leukemia. Dentists, especially periodontists, should be aware of the oral manifestations of ALL and coordinate with medical professionals to establish a comprehensive, long-term treatment plan. Periodontal health in adolescents with ALL can improve significantly with leukemia remission and appropriate basic periodontal therapy.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Key points&lt;/h3&gt;\u0000 \u0000 &lt;div&gt;\u0000 &lt;ul&gt;\u0000 \u0000 &lt;li&gt;Oral manifestations as early indicators: In adolescents with acute lymphoblastic leukemia (ALL), systemic symptoms may be minimal or absent. Early recognition of oral changes, such as gingival swelling or bleeding, is crucial for timely diagnosis.&lt;/li&gt;\u0000 \u0000 &lt;li&gt;Long-term periodontal recovery: A 10-year follow-up indicates that periodontal health can improve following leukemia treatment and basic periodontal therapy, although longer follow-up is recommended to assess the stability of recovery.&lt;/li&gt;\u0000 &lt;/ul&gt;\u0000 &lt;/div&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Plain language summary&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;It is challenging to recognize systemic diseases early through oral manifestations in adolescents, which is critical for accurate diagnosis. Acut","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"16 1","pages":"107-114"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}